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Cambodia’s frontline heroes in the fight against drug-resistant malaria

6 April 2014

Village Malaria Workers or VMWs are trained by Cambodia’s National Malaria Control Programme and its partners, with technical support from WHO, to deliver malaria prevention and treatment services to remote villages. In Battambang province, VMWs like Chhiv Khea are also trained to ensure patients receive a malaria test and complete the full course of treatment with artemisinin-based combination therapy (ACT) when found positive, thus contributing to the rational use of ACTs and the elimination of malaria parasites that are resistant to artemisinin and/or its partner drugs.

WHO

Village malaria worker Chhiv Khea

It is 10 o’clock in the morning in Battambang Province’s O Nonong village along Cambodia’s northwestern border with Thailand. 23-year-old Chhiv Khea is busy working on her cassava farm with her newly-wed husband and other farmers.

Then, her mobile phone rings. A sick pregnant woman has come to Khea’s village house in the Ta Sanh commune to seek her help. The woman suspects she has malaria and wants to get a blood test and treatment if she has the disease. Pregnant women are particularly vulnerable to malaria infection and malaria during pregnancy has devastating effects not only on mothers, but also on newborns and infants.

As a voluntary village malaria worker, or VMW, Khea politely asks the young mother to wait and tells her she will arrive in about 10 minutes. Khea hops on her motorcycle and drives home from her farm about three kilometers away.

As she arrives home, Khea hurriedly begins her usual interview and diagnosis to determine whether the woman has malaria.

“What is your name?” she starts asking the woman.

“Khuth Poeun.”

“How old are you?”

“24.”

“Why do you want to have a blood test?” Khea quickly gets to her point.

For generations, people in O Nonong village were firmly entrenched in their traditional beliefs. When people fell sick with an illness like malaria, they would pray to the spirits of the land and water and seek treatment with herbal medicines. Now, however, things are different. With malaria, people in O Nonong village – and others like it – can get blood tests and free quality treatment from a VMW like Khea.

Khea says she became a VMW three years ago after her mother, who was her predecessor in this position, requested the Ta Sanh Commune Health Center to let her continue the voluntary work in O Nonong village.

Khea explains how she became involved in the programme. “My mother was getting old and she couldn’t see clearly. She asked me to go to the monthly VMW meetings and prepare reports for her.” After getting a nod from the chief of the health center, Khea says her mother began to prepare her for the work and then she underwent training organized by Cambodia’s National Malaria Control Centre (CNM) and its partners, with technical assistance from WHO.

“I used to watch my mother doing blood tests using the RDT (Rapid Diagnostic Test) kits and treating patients with malaria,” Khea recalls. “That prepared me for the work ahead,” she adds.

It is important to have VMWs. In the past, many people were sick with malaria. Now, there are fewer and fewer malaria cases due to the work of VMWs.

Chhay Sovanda, chief of O Nonong village

Then, she says, she attended workshops in September 2010 organized by the USAID-funded University Research Co. (URC) in partnership with WHO and CNM, on how to diagnose malaria using RDTs, and to administer ACTs following the Directly Observed Treatment protocol (DOT) for those who tested positive for falciparum malaria. DOT is important because failure to complete the full ACT treatment course can also contribute to the development of resistance to artemisinin and/or partner drugs.

Khea says each month during the rainy season she gets around 20 people who come to have their blood tested for malaria and she usually finds two or three cases, particularly among migrant workers and people from remote villages. However, she says work is more difficult during the rainy season when she has to travel in difficult conditions to the houses of malaria patients to personally supervise the intake of their medicines.

“Every day, for three days, I watch the patient take their daily dose in front of me and I make sure they don’t run away after getting a bit better. But during the rainy season it’s quite a task getting to their houses because of the slippery mud on the tracks and also the landmines,” she points out. Despite intensive de-mining efforts, there are still numerous explosive remnants of previous wars remaining in the ground in Battambang province and flooding often dislodges them, posing a serious threat to villagers.

“At the beginning, it was difficult for me,” Khea says. “I was afraid that it would be very embarrassing if I made a mistake.” However, she says people started to trust her as she became skilled in her malaria work after attending more refresher trainings organized by URC. “I feel proud that people like me now,” she says with a smile.

CNM and its partners, with technical support from WHO, have trained over 1800 village malaria workers in key provinces where malaria is rife. Battambang province has 125 VMWs trained by URC, with support from WHO and CNM, on the DOT protocol. A similar partnership with WHO and CNM was entered into with the NGO Family Health International (FHI 360) and Malaria Consortium to upgrade the skills of 114 VMWs in Pailin province.

Chhay Sovanda, chief of O Nonong village, agrees that the VMW programme is essential in the fight against malaria.

“It is important to have VMWs,” says the female village chief. “In the past, many people were sick with malaria. Now, there are fewer and fewer malaria cases due to the work of VMWs.”

The village chief also speaks highly of Khea. “She does very good work. She is very punctual and will come immediately if she hears that somebody is suspected of having malaria.”

Now, it has been 20 minutes since Poeun had her blood test.

“You do not have malaria,” Khea tells Poeun.

“I am happy to hear that I have no malaria,” the pregnant mother replies delightedly.